Saturations tissulaires en oxygène dans le choc septique (disparités temporelles et spatiales de 5 territoires)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

A Case-report of Unpredictable and Massive Voriconazole Intoxication in a Patient with Extensive CYP2C19 and CYP2C9 Polymorphisms.

International audienceThis case-report describes a massive voriconazole (VRZ) intoxication in a patient with a poor metabolizer profile, highlighted by low plasma main metabolite concentrations (N-oxide voriconazole), despite an extensive genetic profile for CYP2C19 and CYP2C9. The patient was treated with a therapeutic dose of VRZ but developed a neurotoxicity leading to hallucinations and coma while the plasma concentration of VRZ reached an exceptional level (20.0 µg/mL on day 10 of the treatment). Since neurological disorders diminished in parallel with the decrease of VRZ plasma concentrations, the coma was likely due to VRZ. The VRZ half-life, calculated to 58 h in this patient, was by far higher than the values reported in the literature. While VRZ concentrations slowly decreased, the N-oxide voriconazole concentrations slowly increased from day 15. Hypotheses for this lack of metabolization of VRZ are an inhibition of the metabolism by esomeprazole, a saturation of the metabolism or an enzymatic auto-inhibition of VRZ metabolism but none of these hypotheses have yet been explored. This case-report of unpredictable accumulation of VRZ in a patient without any genetic risk factor is an advocacy for systematic therapeutic drug monitoring of VRZ

Rombencephalitis caused by Francisella tularensis.

International audienceCommon presentations of tularemia include pneumonia and ulceroglandular, oropharyngeal, or typhoidal disease. Neuromeningeal involvement is extremely rare. We report a case of a severe rhombencephalitis due to Francisella tularensis. Diagnosis was possible thanks to a very precise interview, and the patient dramatically improved after specific antibiotherapy

A "Kelp-Like" Microorganism Within the Belly

International audienceA 50-year-old woman suffering from paranoid schizophrenia with carelessness symptom was referred on day 0 for peritoni-tis caused by a perforated gastro-duodenal ulcer. In her recent medical history, anorexia, constipation, and impairment of general health condition were reported. A biological inflam-matory syndrome was noticed at admission, with C-reactive protein of 320.1 mg/L, procalcitonin of 216.68 µg/L, and polymorphonuclear neutrophil count of 16.4 × 10 9 /L. To note, blood calcium, total serum protein, and hemoglobin were low at 1.77 mmol/L, 40 g/L (including 16 g/L for albumin), and 81 g/L, respectively. Several intraperitoneal abscesses were detected by computed tomography on day 3 (Figure 1). Abscess aspirate showed a moderately inflammatory liquid with no malignant cells (day 4). On the third day following Figure 1. Medical imaging of abdomen. Noncontrast computed tomography scan showed 3 large abscesses within the peritoneum on day 3 (abscesses' sizes = 29.3 × 15.4 mm, 28.4 × 15.2 mm, and 82.2 × 47.1 mm). Figure 2. Microbiological findings from the abscess aspirate. A, After 6 days of culture, creamy, pale (instead of "whitish"), yeast-like colonies with flat rough texture. B, Microscopic observation of positive culture through fresh mounting (magnification ×400). C, Microscopic observation of positive culture according to calcofluor method (magnification ×400)

Analytical comparison of ELISA and mass spectrometry for quantification of serum hepcidin in critically ill patients

International audienceAim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability to diagnose true iron deficiency anemia in critically ill patients. Materials & methods: Serum hepcidin was measured in 119 critically ill patients included in the HEPCIDANE clinical trial, using either an ultra-sensitive ELISA kit (from DRG) or two different MS methods. Results: The results show a good correlation between the different methods studied. The Bland–Altman analysis and the Kappa test for clinical groups show a good or very good agreement between the different tests. Conclusion: ELISA or MS show a satisfactory commutability to quantify serum hepcidin. This is of great importance for the determination of therapeutic strategies in iron deficiency

Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial

Abstract Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was &lt; 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin &lt; 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day 90 mortality and 1-year survival. Results Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). A total of 220 patients (55%) had ID at discharge (i.e., a hepcidin &lt; 41 μg/l). Primary endpoint was not different (medians (IQR) post-ICU LOS 33(13;90) vs. 33(11;90) days for intervention and control, respectively, median difference − 1(− 3;1) days, p = 0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference − 8.7 (− 15.1 to − 2.3)%, p = 0.008, OR 95% IC, 0.46, 0.22–0.94, p = 0.035), and one-year survival was improved (p = 0.04). Conclusion Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay. Trial registration www.clinicaltrial.gov NCT02276690 (October 28, 2014; retrospectively registered) </jats:sec

Analytical comparison of ELISA and mass spectrometry for quantification of serum hepcidin in critically ill patients

Aim: To compare methods of quantifying serum hepcidin (based on MS and ELISA) and their ability to diagnose true iron deficiency anemia in critically ill patients. Materials &amp; methods: Serum hepcidin was measured in 119 critically ill patients included in the HEPCIDANE clinical trial, using either an ultra-sensitive ELISA kit (from DRG) or two different MS methods. Results: The results show a good correlation between the different methods studied. The Bland–Altman analysis and the Kappa test for clinical groups show a good or very good agreement between the different tests. Conclusion: ELISA or MS show a satisfactory commutability to quantify serum hepcidin. This is of great importance for the determination of therapeutic strategies in iron deficiency. </jats:p